Dupilumab Associated With Reduction of Food-Specific IgEs at 12, 24 Months

Research that was published in the Journal of Allergy and Clinical Immunology and presented at the 2025 American Academy of Allergy, Asthma & Immunology (AAAAI)/World Allergy Organization (WAO) Joint Congress demonstrated that dupilumab (Dupixent; Sanofi, Regeneron) was associated with a reduction of specific immunoglobulin E (IgE) to specific allergic foods at 12 and 24 months following treatment. Additionally, patients treated with dupilumab passed food allergy challenges.¹

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Dupilumab is a biologic agent that targets the type 2 cytokines IL-4 and IL-13, which are key drivers of type 2 inflammation, inhibiting their signaling. Currently, dupilumab has FDA-approved indications for allergic and inflammatory conditions, such as chronic obstructive pulmonary disease, atopic dermatitis, chronic rhinosinusitis with nasal polyps, asthma, and eosinophilic esophagitis.² Although dupilumab is not currently indicated for any IgE-mediated food allergies, this process is also driven by the type 2 cytokines. For this reason, investigators hypothesized that dupilumab may decrease IgE in patients with comorbid food allergies.¹

Prior research published in Annals of Allergy, Asthma & Immunology in 2023 demonstrated the statistical significance of dupilumab when decreasing food-specific IgE compared with controls. The retrospective, case-control study analyzed the rate of decline of various food-specific IgEs for 20 patients who received dupilumab against 39 patients who did not receive dupilumab. Participants were matched by age and comorbidities.³

This study determined that the total peanut IgE in the dupilumab group had a median absolute IgE and percentage change of about -0.98 kU/L and -3.67% per month, respectively, compared with the control group, which was about 0.0 kU/L and 0.0% per month (p < .05 for both). The average months between the IgE values of the dupilumab group and control group were 29.5 ± 33.2 and 40.6 ± 42.1, respectively.³

For other foods, the absolute rate of change per month was statistically significant for egg, milk, walnut, and hazelnut, and the rate of percentage change was statistically significant for egg, milk, walnut, hazelnut, and cashew. Among the study population, 7 patients have started tolerating various foods. Dupilumab appeared to cause a statistically significant decrease in food-specific IgE compared with controls, but the investigators called for additional research to confirm these findings and further assess dupilumab’s clinical application in food allergies.³

The current study¹ enrolled patients with comorbid food allergy diagnoses with at least 2 measured IgE levels prior to dupilumab initiation and 1 level more than 2 months following initiation. Percent decrease in IgE level over time was assessed for existing IgE levels up to 84 months following initiation, and anticipated IgE level was linearly interpolated for the entire cohort and specific allergens at 12 and 24 months.¹

The data show that at the 12-month point, there was an approximate 56.9% reduction in IgE among all participants (n = 71; p < .001), and at the 24-month point, there was a 73.5% reduction (n = 37; p < .001). Additionally, among those who passed food challenges, there was a 69.4% reduction (n = 13; p = 0.012) at 12 months and an 81.8% reduction (n = 6; p = .027) at 24 months.¹

These studies demonstrate the potential of dupilumab as a potential treatment for IgE-mediated food allergies. The results suggest that dupilumab can significantly reduce IgE levels and improve food tolerance in patients with comorbid food allergies; however, further research is needed to confirm these results and assess its long-term efficacy and safety.

REFERENCES

1. Lothamer E, McLaughlin A, Koleilat M. Impact of dupilumab on food-specific IgE levels in food-allergic patients. J Allergy Clin Immunol. 2025;155(2, Supplement):AB457. doi:10.1016/j.jaci.2024.12.1061

2. Dupixent® (dupilumab) HCP Website. DUPIXENT® (dupilumab) HCP Website. Accessed March 26, 2025. https://www.dupixenthcp.com/

3. Cheng S, Kumar BP, Freeman A. Impact of dupilumab on food-specific IgE levels. Ann Allergy Asthma Immunol. 2023;131(5, Supplement 1):S72. doi:10.1016/j.anai.2023.08.217